The King's Speech
Somehow I missed the policy
implications in The King's Speech until seeing the movie this past weekend. A newspaper of the time
called Lionel Logue "the quack who saved a king," because Logue had
no credentials in speech therapy. This man with no formal training was able to
help Prince Albert become King George VI, and the king then used his improved
public speaking to help the British Empire through World War II.

So why does North Carolina not only license medical professionals, but also
limit their scope of practice? All the evidence suggests that this is a waste
of time, toil, and talents. There is no improvement in health, less access to
care, and higher costs for the care that is available. We have detailed some of
the problems with occupational
licensing in general and have offered ways to deregulate
the medical professions.

The state's budget
The House will pass its budget bill this week. We'll look at three notable areas of difference from
Gov. Perdue's budget in HHS.

The House would spend 25 percent less than the governor to run the
department, mainly by reducing funding for non-profit organizations and
eliminating vacant positions.

The House saves $217 million in Medicaid with $90 million more savings from
the Community Care North Carolina managed care system, plus $109 million in
lower reimbursement rates for providers and inflationary adjustments.

The House also reduces Mental Health Spending by $120 million, though just
$48 million of that is on-budget. It rolls back a $75 million deposit to the
Mental Health Trust Fund, then has one-time savings of $45 million through less
state funding of community services. Of that, $25 million may be offset by
local mental health care managers dipping into their $65 million
undesignated/unreserved fund balances.

A conflict of visions
Donald Berwick, the
lame-duck head of Medicare and Medicaid, wrote in the Wall
Street Journal last week about how government edicts can make health care
as efficient as other areas of the economy where markets are allowed to work.
Berwick is "romantic about the [British] National Health Service" and
thinks we should "ration with our eyes open," which means "at
some point we might say nationally, regionally, or locally that we wish we
could afford it, but we can't." He almost never acknowledges a role for a
personal decision on what is affordable and worthwhile. He defends ObamaCare
saying, " The alternative [to national rationing] would limit services and
shift onerous burdens to the people who need care the most." I highlighted
Paul Krugman's take on this last
week.

Doug Perednia has a thorough response
to Krugman. Mark Pauly in the journal Health
Affairs finds that market-driven
"disruptive innovation" could accomplish all the stated goals of
ObamaCare as consumers choose the best value proposition for care in terms of
convenience, cost, and quality. "An example would be to provide lower-cost
substitutes for some aspects of primary physician care, in the form of care at
a retail clinic. Consumers might not perceive a clinic as a perfect substitute
for physician care, but they might prefer the greater convenience and lower
cost. Perhaps a little less quality for a lot less money might be acceptable to
consumers and taxpayers, as we work to keep medical spending from siphoning off
funds required for other needs."